Other Infections

The World Health Organization (WHO) last week issued an alert informing healthcare providers about a new coronavirus that has so far caused 1 known death due to respiratory illness and kidney failure. The agency issued an interim case definition and asked providers to be on the lookout for new cases.

The novel coronavirus causes respiratory illness with flu-like symptoms. It is related to the SARS coronavirus that was responsible for the outbreak of severe acute respiratory syndrome starting in Hong Kong in 2002-2003. WHO said, however, that the viruses are "very different." Coronaviruses also cause milder illness such as the common cold. Preliminary findings suggest the new virus may be spread by bats.

The new virus was first identified in a 60-year-old man in Saudi Arabia who died several weeks ago after developing pneumonia and kidney failure. Extensive testing revealed that he was infected with a coronavirus, but not one of the known types. Another 49-year-old man, who originally came from Qatar and had recently visited Saudi Arabia, became critically ill with respiratory illness and kidney failure in early September, and was found to have a nearly identical virus (he is now under care in the U.K.).

Since then, another 5 suspected cases were reported in Denmark -- a family of 4 plus an unrelated individual -- but they were found to have influenza. There have been other unconfirmed reports in Jordan. Public health experts have expressed concern about the potential spread of the virus among the large influx of people who will make the Hajj pilgrimage to Saudi Arabia later this month.

Based on the small number of cases to date, WHO has stated that, "there is no evidence so far of person to person transmission of the novel coronavirus." In a media briefing last week, WHO spokesperson Gregory Hartl said, "this is not SARS, it will not become SARS, it is not SARS-like." But this is not entirely good news: unlike SARS, the new virus appears to cause "very rapid" kidney failure.

WHO asked clinicians to be on the lookout for additional people with suspicious respiratory illness, especially if they have recently visited Qatar or Saudi Arabia. According to agency's preliminary case definition, an individual with unexplained acute respiratory syndrome that may include fever of at least 38°C (100.4°F) and cough that requires inpatient care, or who has suspicion of lower airway involvement based on clinical or radiological evidence, should be considered a "patient under investigation."

Suspicion should also be aroused, the agency continued, based on epidemiological criteria including close contact with a probable or confirmed case or travel to or residence in an area where infection with the new coronavirus has been reported or where infection could have occurred. A "probable case" is someone who meets both clinical and epidemiological criteria. A "confirmed case" requires laboratory evidence of the presence of the new virus.

Public health officials are now working to develop a specific diagnostic test. At this time WHO does not advise special screening at points of entry or any travel or trade restrictions.